What is Alzheimer's Disease?

This is a short explanation of Alzheimer’s disease and gives a simple illustration of its progression in the brain.

WHAT DO I NEED TO KNOW ABOUT ALZHEIMER'S DISEASE?

Alzheimer’s disease starts very slowly. It is a progressive disease that is fatal with symptoms that get worse over time, generally lasting from 8 to 10 years. Most often, it is diagnosed in people over age 65 but can occur much earlier.

You will hear the terms Amyloid Plaques and Neurofibrillary Tangles, as they are responsible for the deterioration of normal brain function. In short, Alzheimer’s starts with difficulty remembering newly learned information and progresses to problems with confusion about time and place, aggression, mood swings, trouble with language; then more serious memory loss, problems with speaking, walking, swallowing, and breathing.

MILD COGNITIVE IMPAIRMENT (MCI)

HOW MUCH FORGETFULNESS IS TOO MUCH?

Mom was initially diagnosed with Mild Cognitive Impairment (MCI) and it is the diagnosis that is usually given when a person is in the very beginning stage of some form of dementia. People can be “slightly more forgetful than they used to be, and more forgetful than they ought to be” says Dr. Ronald Peterson, M.D. Ph.D., the physician who diagnosed Ronald Reagan in 1994.

Alzheimer’s is responsible for the majority of all dementias, but there are other forms of cognitive impairment such as Vascular Dementia, Frontotemporal Dementia, Dementia with Lewy Bodies and others, and the treatments or management can be different. Memory problems can even occur from a vitamin B12 deficiency or a thyroid problem. It is best to get an evaluation from a doctor if you are having concerns about a loved one’s memory.

In the very beginning, the symptoms are not drastically noticeable. You may find yourself wondering if you are imagining that there is a problem. The person repeats questions or stories and has trouble remembering something that just happened. They may struggle to remember familiar words or names of family members, but then the next day they can seem perfectly normal. They usually deny that there is a problem.

As time progresses, the disease moves toward more difficult characteristics and the person may seem somewhat depressed or moody. There may be mild coordination problems and depth perception may affect driving skills. They may miss doses of medication, be unable to handle finances or have trouble preparing meals. They may get lost in familiar places. This stage can last approximately 2 to 4 years.

The stages start to overlap which is one of the problems with diagnosing what is wrong. The person starts to have more difficulty covering up the problems. They need more and more help with the activities of daily living and can become suspicious of people stealing or lying. There is persistent memory loss including forgetfulness about personal history or knowing names of family members or even if they have just eaten a meal or taken medications. They are likely to become lost in familiar settings and can have sleep disturbances or hallucinations. There are changes in mood and behavior, which can be aggravated by changes in routine such as moving or a trip to the hospital. Even choosing the right clothes to wear or getting dressed without help becomes difficult.

Judgement about health, finances or safety is poor. Mobility can be affected by slowness or tremors, and falls become more common. They may be unable to communicate pain, and therefore, be combative out of frustration. Eventually they become incontinent. This is the longest stage and can last approximately 2 to 10 years.

I remember asking a support group leader what the severe stage of Alzheimer's disease was like. Her answer to me was that I didn't want to know. I didn't think that was helpful. I knew that eventually Mom would end up in bed and wouldn't know me. There is confusion about the past and the present, then a loss of ability to remember, communicate or process information. There is eventually a loss of ability to walk even with a walker or transfer to a wheel chair without assistance. They loose the ability to use eating utensils without help. There becomes an inability to swallow liquids without the help of thickeners. In the severe stage, the person will need round the clock care. Finally, at the very end, the brain forgets to tell the body how to breathe. The severe or late stage characteristics can last from 1 to 3 years.